Provider Demographics
NPI:1497937692
Name:KELLISON, LEZLIE NEUSTETER (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEZLIE
Middle Name:NEUSTETER
Last Name:KELLISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEZLIE
Other - Middle Name:K
Other - Last Name:NEUSTETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1716
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759
Mailing Address - Country:US
Mailing Address - Phone:562-618-5391
Mailing Address - Fax:619-400-5159
Practice Address - Street 1:389 SW SCALEHOUSE CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3241
Practice Address - Country:US
Practice Address - Phone:626-185-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical